<form action="https://www.coinpayments.net/index.php" method="post">
<input type="hidden" name="cmd" value="_pay_simple">
<input type="hidden" name="reset" value="1">
<input type="hidden" name="merchant" value="[merchant_id]">
<input type="hidden" name="currency" value="USD">
<input type="hidden" name="amountf" value="[amount]">
<input type="hidden" name="item_name" value="[item_name]">
<input type="hidden" name="item_number" value="[item_number]">
<input type="hidden" name="custom" value="[user_id]">
<input type="hidden" name="ipn_url" value="[notify]">
<input type="hidden" name="success_url" value="[return]">
<input type="hidden" name="cancel_url" value="[cancel]">
<input type="hidden" name="cstyle" value="list1">
<input type="image" src="[merchant_button]" border="0" name="submit" type="submit" alt="Purchase with CoinPayments"></form>